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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK r MONITORINGPLAN (Page2of2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 4aFUY r 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 4Y0-54b ❑ 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE fit 4.NO DISPENSERS ❑99.OTHER S Y 4w 440-56. �ss MODEL F: PANEL MANUFACTURER: -- '191r's' MODEL A(S): LEAK SENSOR MANUFACTURER: rosy DETECTION OF A LEAK INTO TF)E UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ❑b.NO 4M.sa UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑b.NO FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO 0-6e UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES ❑It.NO 4Yosx 4wRs 2.UDC CONSTRUCTION 15 ❑ LL®1.SINGLE-WA ❑2.DOUBLE-WALLED N a U 1^J� tR DOUBLE WALLED: UDC Dn EMTMAL SPACE IS MONITORED BY: 1.L[ UID 02.PRESSURE Ej 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO VIL PERIODIC SYSTEM TESTING I. ELI)TESTING FACILITY NAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THATLEAK DETEC ENHANCED 4wws. TIO MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 Yo s [if 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. ®3.SPILL BUC[Oi7'S ARE TESTED ANNUALLY 4Yoss VQL RECORDKEEPING 'fhe following naniaringlmaintermna recomis are kept far this facility: [�Alarm logs rro+,a. ®Visual Inspection Records�b ❑Tank integrity tasting results♦Yoram ❑SIR testing results(and supporting dnuncentation records). 4axaa ❑ Tank gauging results(and supporting documentation records). +Yasae ❑ATG Testing results(and supporting documentation records).rau4sl ❑ Corrosion Protection 60-day lags+Yonas - 50 Equipment maintenance and calibration records. 4Yoca M TRAINING 03 Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirlob duties. 4m REFERENCE DOCUMENTS MAINTAINED AT FACT-ITY(Check all that appy) ! ®THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)aYoeYb ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required n& ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4suew ❑CALIFORNIA UNDERGROUND STORAGE TANK LAW 4mtne ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB)PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"amen ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMT"4YocYa OTHER(Specify):M691rawri Qt7 This Facility has a"Designated UST who has passed the California UST System Operator Exam administered by the International Code Council(ICC). The"Designated UST Operator"will main facility employees in the proper operation small maintenance of the UST systems annually,and within 30 days of hire.This training will include,bar is rat limited to,the following: > Operation of the UST systems in a cri,m consistent with the facility's hest management practices > The facility empayee's role with regard to the monitoring equipment as speifted in this UST Monitoring Plan > The facility employee's tole with regard m spills and overfills as specified in the UST Response Plan > Names of contact person(s)fm emergencies and nan¢oring alarms.440-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comnnens hem or indicate low many pages wan addnnmot�ayyinformation on specific monitoring procedures are attached to this plan.440-71 vsr Jdev» c3 XL PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that:1)the timly/tuition,UST mmritning activities and maintenance of UST leak detection equipment covered by this plan occurs,2)all conditions Nat indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The sol lowing persoMs)are responsible for performing the monitoring and equipment maintenannce. NAME. {A r 4Yo-rz TITLEL ^x'71 NAME 440-74 'UTLE 4 's The Designated Operator shall perform a monthly visual inspection of the facility,provide a repro to the owner/opera or.and infotm the owner/operator of any conditions that need follow-up action XIL OWNEWOPERATOR SIGNATURE CERTIFICATION:1 certify that the information provided herein is true and accurate to the best of my Imtnvledge. APPLICAam s' NT,SL{IGN�A(T�U�REs ,(tI_.1`L rays DAZE: '"s"' �— ""''(-Lx-C_-Cll LJ — a—" r era 4-A T TITLE: APPLICANT NAME(print): APPLICANC r r UPCF UST-D(1221107)314